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Moderate Alcohol Consumption May Be More Harmful for People with HIV

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People with HIV taking antiretroviral therapy (ART) had a higher likelihood of death and physiological harm at a lower level of alcohol consumption than HIV-negative individuals, according to a report published in the January 28 advance edition of Drug and Alcohol Dependence. This study "suggests the threshold for safe alcohol consumption is likely different for people with HIV," said lead author Amy Justice.

Justice and fellow investigators with the Veterans Aging Cohort Study (VACS) conducted a study to evaluate whether HIV-positive people may be more susceptible to alcohol-related harm than HIV-negative people.

The study looked at 18,145 HIV-positive and 42,228 HIV-negative individuals in the VACS -- a large cohort of people receiving care through the Veterans Health Administration -- who had an "Alcohol Use Disorders Identification Test-Consumption" AUDIT-C score recorded between 2008 and 2012.

The analysis adjusted for potential confounding factors including age, race/ethnicity, smoking, and hepatitis C coinfection. Being a veterans cohort, most participants were men. About three-quarters of HIV-positive participants were on ART with an undetectable HIV viral load (which the study defined as below 500 copies/mL).

Results

  • The threshold for an association of alcohol use with mortality and physiological injury of frailty differed by HIV status.
  • Among HIV-positive participants, those with an AUDIT-C score of >4 had a higher risk of mortality (hazard ratio [HR] 1.25), as did those who consumed 30 or more alcoholic drinks per month (HR 1.30).
  • Among HIV-negative people, in contrast, only those who had a higher AUDIT-C score of >5 and drank 70 or more drinks per month had increased mortality (HR 1.19 and 1.13, respectively).
  • Similarly, AUDIT-C scores of 5-7 were associated with physiological injury among HIV-positive individuals, while only scores of 8 or more raised the risk for HIV-negative people.

"Despite antiretroviral therapy, HIV-positive individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals," the study authors concluded. "Alcohol consumption limits should be lower among HIV-positive individuals."

This is the first study to demonstrate the increased harm among patients who have suppressed HIV with modern antiretroviral treatment, according to a Yale University news release. Even consumption of 1 or 2 drinks per day was associated with increased risk for people with HIV.

"It demonstrates that even among people on ART with suppressed viral load, who are much less sick in general, there is still an added effect of alcohol among those individuals than people without HIV," said Justice.

2/5/16

Reference

AC Justice, KA McGinnis, JP Tate, et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug and Alcohol Dependence. January 28, 2016 (online ahead of print).

Other Source

Z Kashef, Yale University. Research in the news: Even moderate alcohol intake may harm people with HIV. Yale news release. February 2, 2016.